سینا مباشری زاده

Today, Glycosylated hemoglobin A (HbA1c) is used as a diagnostic criterion for diabetes and long-term monitoring of plasma glucose level. Therefore, it is essential that HbA1c be measured accurately. The aim of this study was to investigate the common HbA1c index measurement methods in laboratories in Isfahan and compare the accuracy of their results with the reference method.

In this cross-sectional study, three blood sample of a volunteer had been sent to 37 laboratories. Among them, two laboratories measured this parameter by HPLC method and were considered as a reference. For each laboratory, the coefficient of variation (CV) was calculated. One-way ANOVA and Bonferroni post hoc test were used to compare the results of different methods of measuring HbA1c with the reference method.

Comparison of the laboratories results with the reference method showed that 60% of the laboratories reported the percent of HbA1c index beyond the permitted range with an unfavorable report. The mean and standard deviation and CV index range were 2.8 and 4.4, (from 0.65 to 25.18%), respectively. Comparison of the different methods results with the reference method showed that capillary electrophoresis and immunoturbidometry and enzymatics had good accuracy. The highest accuracy was related to capillary electrophoresis. The methods with the lowest measurement accuracy were nephelometry and column chromatography, respectively.

Despite the standardization of methods for measuring HbA1c, it was noted that different results of the same blood sample was reported. In addition to the High Performance Liquid Chromatography method, the capillary electrophoresis seems to provide a more acceptable result than other methods.

In developing countries, the presence and diversity of Staphylococcus species in foodstuffs have not been comprehensively studied. So, the present study aimed to investigate the dissemination of Staphylococcus spp. and their antimicrobial susceptibility pattern isolated from foodstuffs in Isfahan in 2015-2016. A total of 194 foodstuff samples were collected from different parts of Isfahan city and processed for the presence of Staphylococcus spp. The conventional tests were used for the primary detection of bacteria and the sequence analysis of 16S rRNA was used for the species identification. The antimicrobial susceptibility pattern of isolates was determined by the disk diffusion method. From a total of 194 food samples, 92 Gram-positive cocci (47.5%) were isolated. Of them, 84 isolates were Staphylococcus spp., 7 Macrococcus spp and one Micrococcus spp. The most prevalent species were S. aureus 25% (21/84), S. vitulinus 15.5% (13/84) and S. succinus sub casei 11.9% (10/84). The most antibiotic resistance rates were against penicillin (59/5%) and tetracycline (20.2%) while the lowest antibiotic resistance rates were observed for levofloxacin, rifampicin, gentamicin, and ciprofloxacin. Characterization of Staphylococcus species is important for epidemiological investigations. Proper identification and management practices including analysis of 16S rRNA for the species identification should be considered to increase food safety and prevent extra treatment costs.

Moraxella catarrhalis a gram-negative bacterium, is a significant cause of lower and upper respiratory infections. The RND family efflux pumps lead to multidrug resistance in gram-negative bacteria. One of the well-known pumps in M. catarrhalis is AcrAB-OprM system. This study aimed to investigate the antibiotic resistance in M. catarrhalis and to determine its antibiotic resistance dependence on the efflux pump.

In this study, 137 different clinical samples were collected. M. catarrhalis isolates were confirmed by biochemical assays and PCR. The antibiotic susceptibility pattern was investigated by disc diffusion method according to CLSI. Phenotypic study of the efflux pumps activity was done using cartwheel method. Study of the acra, acrb, and oprm genes were performed by, PCR. In addition, the association of efflux pump with antibiotic resistance was investigated using phenylalanine-arginine β-naphthylamide.

Of 10 isolated M. catarrhalis, 70% (7 isolates) showed multiple antibiotic resistance. The resistance to cefazolin, ceftazidime, tetracycline, chloramphenicol, and ciprofloxacin antibiotics was also dependent on the efflux pump.

The results showed that multiple antibiotic resistance has increased in Moraxella catarrhalis. The 70% presence of acra, acrb, oprm efflux genes of the efflux pumps in this bacterium and antibiotic resistance reduction in the presence of efflux pump inhibitor shows the importance of examining these genes’ presence to suggest a suitable treatment model for the patients infected with M. catarrhalis.

Introduction & Fluoroquinolones are essential antimicrobial agents used to treat UTIs. Clinical experiences have shown a high rate of antibiotic resistance among uropathogens. These resistance are usually the consequence of mutations involving genes encoding gyrA and parC. The aim of this study was to determine antimicrobial resistance pattern and the presence of mutations in regions that code for quinolone resistance in the genes gyrA and parC in clinical isolates of E. coli from a hospital in Isfahan, Iran.
A total of 135 isolates of E.coli (from urine) were collected from September to February 2013 from Alzahra Hospital (Isfahan, Iran). Bacterial susceptibility to antimicrobial agents was determined using disk diffusion method. PCR was performed to detect genes gyrA and parC. Then, 13 isolates were randomly chosen for genetic characterization of the quinolone-determining region (QRDR) of the parC and gyrA genes.
Among 135 E. coli isolates, 61 isolates ( 45 % ) were resistant to fluoroquinolones. From 13 isolates, 11 isolates showed two mutations (Ser83Leu/ Asp87Asn) and 2 isolates showed a single mutation (Ser83Leu) in gyrA gene. Also, five different mutations were detected in parC gene in the E. coli isolates, encoding Ser80Ile, Ser80Val, Ser80Arg, Glu84Val, Gly78Ser.
More research on the molecular basis of FQ resistance is required to develop new therapeutic strategies for FQ-resistant E. coli. To overcome antibiotic resistance antibiotic therapy should be limited and based on the susceptibility patterns of microorganisms.

Phagetherapy is the therapeutic use of bacteriophages to treat pathogenic bacterial infections as alternative to antibiotics for treatment of resistant bacteria. The aims of this study were to isolate, identify and evaluate effective bacteriophages active against antibiotic resistant strains of Pseudomonas aeruginosa.
Different Pseudomonas aeruginosa strains isolated from clinical specimens during 9 months (July 2013 to March 2014) in three Isfahan hospitals (AlZahra, Omid and Shahid Beheshti hospitals) and Kirby Bauer's disc diffusion method was used for determination of resistance profiles of these isolates using different antibiotics including Amikacin, Imipenem, Meropenem, Ciprofloxacin, Ceftazidime, Cefepime, Cefotaxime, Piperacillin-tazobactam. The resistant strains to all tested antibiotics were selected for finding their specific bacteriophages from waste water and
hospital sewage. Presence of phage investigated by plaque formation and after enrichment and stained of samples, TEM microscope was used for determination of phage morphology and size.
Findings: Among 81 Pseudomonas aeruginosa isolates, 38 isolates (47%) were resistant to all tested antibiotics and plaque due to phages was detected against 32 (84%) among these 38 isolates. Two phages belong to Cystoviridae and Leviviridae identified using TEM microscope.
Discussion & It seems that the mixture of two phages (cocktails phages) that has high bactericidal effect against resistant strains of Pseudomonas aeruginosa can be good candidates for use in phagetherapy.

Extended-spectrum beta-lactamase of CTX-M-type is considered as an important mechanism resistant to beta-lactam drugs in the gram-negative pathogens. In this study, the prevalence of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli) as well as the frequency of CTX-M genes from urinary tract infections in inpatients and outpatients caused by Escherichia coli in selected health centers in Isfahan, Iran, was studied in 2013. The study was carried out on 120 E. coli isolates from inpatients and outpatients with urinary tract infection. The susceptibility of isolates was tested using disc diffusion method. The ESBL-producer strains were confirmed using combined discs method. Finally, the blaCTX-M gene was determined in ESBL-producer isolates using polymerase chain reaction (PCR) method. To identify the strains of E. coli producing CTX-M genes, PCR method was used. The collected data were entered and analyzed in WHONET 5.6 and Excel softwares. From 120 strains of E. coli, 12 outpatient (20.0%) and 33 inpatient (55.0%) isolates were ESBL-producer. 84.4% and 60.1% of outpatient isolates and 94.9% and 84.8% of inpatient isolates showed resistance to ampicillin and co-trimoxazole, respectively. PCR analysis revealed that 30 isolates had CTX-M gene. The production of ESBL, in particular in isolates of inpatients, is a big threat for use of the broad-spectrum cephalosporins. Given the presence of CTX-M gene in the high proportion of the isolates, more molecular and epidemiological studies on pathogenic bacteria in health centers is required to be able to have a common plan to control bacterial resistance.

Multi-criteria comparison between laboratories is important for laboratory management to improve performance and for policymakers to make strategic decisions. In this study, those aspects of performance are considered that are beyond the traditional evaluation carried out by checklist. After the identifying the effective measures, a comprehensive performance evaluation model was presented and the performance of each laboratory was evaluated regarding the use of resources, including personnel, materials, equipment, space and facilities. Data envelopment analysis (DEA), using output -oriented model with constant returns to scale (CRS), was used to evaluate the efficiency of the labs. the input variables were different kinds of the costs related to staff, material, equipment, space and facilities; physical standards associated with personnel, equipment, materials, space and facilities; process standards: safety, pre-test process, test process, quality control and after-test process; systems standards related to purchase and inventory, communications and information. The application of the proposed procedure for comparing the performance of 18 selected laboratories has shown that only 17% were efficient. The model is also used to determine the causes of inefficiency and to propose the policy for improving performance.

The antibiotic resistant of In Enterobacteriaceae bacteria family to carbapenem drugs is continuously increasing. The aims of this study were to determine the prevalence of carbapenems resistance in multidrug-resistant (MDR) strains of E. coli and Enterobacter and to determine their standard antibiotic resistance patterns and frequency of Klebsiella pneumoniae carbapenemase (KPC) enzyme in Isfahan.

This cross-sectional study, was carried out on 300 clinical samples collected from three hospitals in Isfahan. Antibiotic susceptibility of bacteria was determined by disk diffusion method. In carbapenem resistant strains, the minimum inhibitory concentration (MIC) of imipenem and meropenem were calculated by E-test. The resistance rate to 31 antibiotics belonging to 17 classes were evaluated. The frequency of MDR, extended drug resistance (EDR) and pan drug resistant (PDR) strains were determined. The prevalence of the KPC enzyme in these strains was determined by phenotype method.

Totally, 191 strains of E. coli and 43 Enterobacter strains were isolated, among them 151 (79%) and 35 (81%) were MDR respectively. In both bacteria, effective antibiotics were carbapenem, piperacillin/tazobactam, amikacin, cefepime and nitrofurantoin. Five strains of E. coli (3.3%) and three strains of Enterobacter (6.8%) were resistant to carbapenems and the MIC results confirmed these results. Overall 7 strains out of these 8 strains were MDR and only one strain of E. coli was XDR. No PDR strain was detected. KPC enzymes in four E. coli strains (6.2%) and two strains  (7.5%) belonged to Enterobacter strains.

This study demonstrated the high prevalence of MDR among hospitalized patients in Isfahan. This results shows the emergent changes in the level of antibiotic utilization in hospitals.

The aim of this study was to isolate and identify KPC (Klebsiella pneumonia carbapenemase) enzyme producing strains of Enterobacteriaceae، and determine their antibiotic susceptibility pattern in three hospitals of Isfahan، Iran. This subject has not previously been investigated comprehensively. KPC detection was done by Modified Hodge Test (MHT) and their antibiotic susceptibility patterns were determined by disc diffusion method. The total of 475 strains were isolated and detected as Enterobacteriaceae during the period of 9 months (July 2012-March 2013) in three hospitals in Isfahan province، Iran. These isolates contained Escherichia coli: 285 strains (60%)، Klebsiella: 128 strains (27%)، Enterobacter aerogenes: 16 strains (3. 4%)، Enterobacter cloacae: 9 strains (1. 9%)، Proteus vulgaris: 12 strains (2. 5%)، Proteus mirabilis: 4 strains (0. 84%)، Citrobacter freundii: 8 strains (1. 7%)، Citrobacter diversus: 3 strains (0. 6%)، Serratia marcescens: 3 strains (0. 6%)، Shigella sonnei: 4 strains (0. 84%)، Salmonella paratyphi A: 2 strains (0. 42%)، and Providencia stuartii: 1 strain (0. 2%). Percentage resistant to ceftazidime and cefotaxime and non-susceptibility to imipenem and meropenem for above isolates were، respectively، as follows: for Escherichia coli isolates 60، 63، 6، and 9; for Klebsiella isolates 70، 75، 55، and 58; for Klebsiella pneumoniae 100، 100، 95، and 94; and for other Enterobacteriaceae isolates 20، 17، 5، and 3. Our results showed that KPC test was positive for 2 isolates (0. 7%) among Escherichia coli strains، 65 (87%) isolates among Klebsiella pneumoniae، and 1 isolate (6%) among Proteus strains. This was approved by Etest based MIC method. In general، our results showed that among Enterobacteriaceae isolates، Klebsiella pneumoniae isolates had higher KPC enzyme production، and most strains had multidrug resistant.

Furthermore application of bacteriocins as alternates for antibiotics، they are fermented as food preservation currently. The aim of this study was isolation and purification of ultraviolet-resistant bacteriocins from enterococci strains active against Listeria monocytogenes. Different strains of enterococci bacteria were isolated and identified from various clinical specimens and bacteriocin production were evaluated against strains of Listeria monocytogenes. An isolate of enterococcus bacteria that produce significant bacteriocin against all studied strains of Listeria monocytogenes was identified based on its phenotypical and biochemical properties as well as its 16SrRNA gene sequencing. In the next stage، this bacteriocin was purified and the effects of proteolytic enzymes، pH، temperature and ultraviolet radiation (UV) on its activity were tested and its molecular weight was determined by SDS-PAGE (Sodium dodecyl sulfate polyacrylamide gel electrophoresis) method. 17 strains of enterococci were isolated and five isolates exhibited an inhibitory effect against Listeria monocytogenes strains and among them، one enterococcus had inhibitory effect against all four strains of Listeria monocytogenes. This enterococcus was identified as Enterococcus faecium strain DSH20 (access number: JX567733. 1). Using proteolytic enzymes led to the loss of antimicrobial activity; so، protein nature of it was confirmed. Bacteriocin production was resistant to UV، high temperature and pH changes. The molecular weight of the bacteriocin was at approximately 35 kilodaltons. Biochemical properties of this bacteriocin، such as thermal stability، resistance to UV radiation and pH، were significant. These properties present it as an alternative of antimicrobial agents against Listeria monocytogenes and preserving of fermented foods.

Patients under hemodialysis are exposed to remarkable volume of water. As dialysis water is in direct contact with patients’ blood, absence of regular disinfection of pipes will facilitate the transfer of the endotoxins produced by bacteria in water to the patient's body. Thus, regular control of dialysis system and water disinfectant equipment is compulsory. This study aimed at comparing relative frequency of positive culture for microorganisms in piped water before and after filtration, culture of water after passing from pipes, and culture of dialysis fluid before entering the dialysis filter in hemodialysis section of Alzahra Medical Center (Isfahan, Iran). During 2010 and 2012, an interventional study was performed in Alzahra Hospital. Samples were taken from piped water before and after filtration and from dialysis fluid before passing from membrane. The obtained samples were cultured in tryptic soy agar (TSA) and the isolated bacteria were then evaluated. Interventions included the disinfection of pipes used for transmission of water and replacement of pipes in hemodialysis section. Purified water was studied before and after passing the pipes. Dialysis fluid was also assessed before and after the intervention. Bacteria had grown in eight out of 14 samples (57%) before the intervention. In fact, five samples developed Escherichia coli, three had pseudomonas, and one had candida. However, after the intervention, only one out of 14 samples was found to have bacteria (alcaligenes) after filtration and before entering dialysis water pipes. According to the results of this study, the probability of bacterial growth is very high in filtration system of dialysis water. Regular disinfection and microbial sampling and culture are hence crucial.

Colonization of bacteria on the equipments in touch with airway and respiratory mucosa may cause respiratory infections. According to available protocols، endotracheal tube connectors should be disposable، but because of financial issues many hospitals use it more than once. In the present study، the colonization rate of endotracheal tube connectors after 24، 48 and 72 hours of administration in multiple patients on mechanical ventilation in the operating room was assessed. In this study، 150 endotracheal tube connectors after repeated use in different patients have been sampled and cultured using standard microbiological methods. Samples were categorized in three groups based on the duration of administration (24، 48 or 72 hours). Colony counts were identified and compared among the three groups. Colonization rate after 24، 48 and 72 hours of usage was 2%، 18% and 30%، respectively (p<0. 05). Separated bacteria usually were in kinds of Streptococci، Bacillus SP، Coagulate negative staphylococci، Klebsiella SP and Mold. Using endotracheal tube connector for more than 24 hours significantly increases the colonization rate. In hospitals with limited financial resources، repeated use of endotracheal tube connector up to twenty four hours maybe acceptable.

The present study was conducted to evaluate the relative frequency of Clostridium difficile (C. difficile) in patients at a university hospital, Isfahan, Iran. This descriptive, analytic study was conducted on 162 patients hospitalized in various wards of Alzahra Hospital (an 800-bed teaching hospital) of Isfahan during October 2009 to March 2010. Fecal samples of patients who suffered from diarrhea after receiving antibiotics were collected. Microbial analysis was performed to determine the existence of C. difficile. C. difficile toxins (A and B) were detected by ELISA method. The obtained data was statistically analyzed using chi-square test in SPSS at a significance level of P < 0.05. C. difficile toxins were detected in 36 (22.2%) patients. The frequency of toxins occurrence was significantly higher in men (P ≤ 0.005). In addition, a large number of individuals infected by C. difficile toxins were children under 4 years of age. Ceftriaxone caused many cases of diarrhea in our studied population. In general, based on our results, wrong prescription and antibiotics abuse can cause infection with C. difficile in patients receiving antibiotics. Therefore, the physicians must pay more attention to the recovery of patients with antibiotics.

Urinary Tract Infection (UTI) is the second most common infection in human. Most of UTIs are due to Escherichia coli (E.coli) and Klebsiella pneumoniae (K.pneumoniae). These bacteria are relevant opportunistic pathogens that account for nosocomial infections. Prevalence of Extended-Spectrum Beta-lactamase (ESBLs) in pathogenic bacteria leads to antibiotic resistance and mortality and morbidity in patients. The best method for controlling strains that produce ESBLs is use of standard method for recognizing ESBLs producer strains. The objective of this study was to evaluate and compare the frequency of ESBLs in Escherichia coli and Klebsiella pneumoniae strains isolated from hospitalized and out-patient with urinary tract infection in selective centers from Esfahan. The research was of descriptive type and performed in Al-zahra, Shariaty, and Kashany hospitals and Reference and Mahdieh laboratories during 2009-2010 in Isfahan. According to statistical formula 378 UTI samples were randomly selected. Bacterial identification was performed with microbiological methods and ESBLs production was performed with screening and confirmatory test. For data analysis, Chi square test and Whonet 5.4 software was used. From 378 samples, 167 bacteria were from hospitalized cases and 211 bacteria were from out-patient samples. Frequency of E.coli in hospitalized and out-patients was respectively 52% and 64% and frequency of K.pneumoniae in hospitalized and out-patient was respectively 64% and 22%. Frequency of ESBLs in E.coli strains in hospitalized and out-patient was respectively 58% and 17% and frequency of ESBLs in K.pneumoniae strains in hospitalized and out-patient was respectively 64% and 22%. The results showed high rate of nosocomial UTI and high frequency of ESBLs in isolated bacteria from hospitalized cases as compared to out-patients that represent high incidence of antibiotic resistant strains in hospitals.

Intravenous drug users (IVDUs) are the most at risk group for viral hepatitis C and injection drug is responsible to more than 60% of HCV infected new cases worldwide. Hepatitis C screening in centers for methadone maintenance treatment (MMT) has several benefits in harm reduction stategies.

In an action research study, after coordinating centers for MMT, questiononaires including demographic and risk factors of HCV were sent to 80 active centes in Isfahan province to complete and add their result for HCV-Ab test.

Only seven centers with 1055 members, sent their completed questionaires to administrators, but most of documents were without any HCV-Ab test results. Overall, 74 (7.0%) participants were positive for hepatitis C.

The results of this study indicated serious problem in execution which was due to lack of cooperration of the center's mannagers, stuffs and members. Hence, it is recommended to do active intervention and consider a reward for future investigators.

Introduction and Escherichia coli and Klebsiella pneumoniae are the most agent of urinary tract infection (UTI) and prevalence Extended-Spectrum Beta-lactamase (ESBLs) in these bacteria due to spread of antibiotic resistance and mortality and morbidity in patients. The best manner for control of ESBLs in bacteria, are inhibition of spread these bacteria and use of standard method for recognizes ESBLs producer strains.Subject of this study was comparison frequency of ESBLs in Escherichia coli and Klebsiella pneumonia strain in UTI acquired patients with phenotypic test. This cross-sectional search was performed in Azzahra and Shariaty hospitals during of 2008-2009 years in Esfahan, according to statistical formula randomly selected 91 samples from urinary infections. Bacterial identification was performed with microbiological methods, ESBLs production was performed with screening and confirmatory test and survey antibiotics resistant pattern was performed with Kirby method. Frequence of ESBLs in E.coli and K.pneumoniae strains was respectively 47.97% and 41.66%. According to antibiogram result respectively 59.2%, 54.9%, 30.3%, 27.8%, 19.5% and 16.7% of E.coli strains were resistant into Co-Trimoxazole, Nalidixic acid, Ciprofloxacin, Gentamicin, Ceftazidime and Nitrofurantoin and respectively 75%, 50%, 40%, 44.5%,37.5%, 37.5%, 22.3% and 0% of K.pneumoniae strains were resistant into Ampicillin, Co-Trimoxazole, Nitrofurantoin, Ceftazidime, Amikacin, Cephotaxime, Imipenem and Ciprofloxacin. The result showed high frequence of ESBLs, so antibiotic resistant in isolated bacteria from hospitalized into out patience's that represent high spread antibiotic resistant strains in hospitals.

Urinary tract infection and resistant organisms are the most serious problems for hospitalization and mortality in spinal cord injured patients. Empirical administration of various antibiotics in hospitals has caused increased resistant organisms involved in UTI in these patients. In this study, the antibiotic sensitivity of organisms isolated from urine samples of spinal cord injured patients with UTI was investigated. It was a cross sectional study which was done on 145 male patients with spinal cord injury and UTI referring to Al-Zahra hospital, Isfahan, from 1384 to 1385. Urine sample was obtained from them on the basis of bladder drainage method (catheter, condom bag or cred maneuver) and was sent for analysis and culture. MIC of various antibiotics on organisms was determined using E test. Mean age of patients was 44/1±2.According to culture results of patient´s urine samples, Ecoli(53.3%), klebsiella(20%), Enterococcus(9.1%), pseudomonas aeroginosa(8.3%), proteus(0.8%), serratia(2.5%),staphylococcus aureus (4.1%) and staphylococcus epidermidis(1.6%) were isolated. Highest rate of positive cultures were seen in patients with permanent catheter.The most percentage of sensitivity of organisms to antibiotics amikacin, ciprofloxacin, gentamicin, trimethoprim/sulfamethoxazol, ceftriaxone and ceftazidim was respectively: in Ecoli %94.1 and Klebciella 100%to Amikacin, in pseudomonas 80% to Amikacin and Ceftazidim, in Enterococcus, Staphylococcus aureus and epidermidis 80% to Vancomycin. The sensitivity of Proteus and Seratia to Ciprofloxacin, Ceftriaxone, Ceftazidim and Amikacin was100%.Sensitivity of gram negative organims to Ciprofloxacin was more than Ceftriaxone and sensitivity of all of them to Imipenem was 100%. The most resistancy of gram negative organisms was to Trimethoprim/Sulfametoxazol and about Enterococcus and Staphylococcus was to Amikacin. With regard to increased risk of urinary tract infection with resistant organisms in spinal cord injury, determination of antibiotic sensitivity has an important role in proper treatment of these patients and prevention of inadvertent use of broad spectrum antibiotics with unknown effect on organisms causing urinary tract infection. Consequently it is useful in prevention of increasing microbial resistance and in reduction of patient's costs.

Introduction. Spinal cord injury leads to increased incidence of urinary infection because of sensory and motor derangements as well as alteration in function of urinary system. Pathogenic factors vary based on differences in geographic regions. Urinary infection in the most common nosocomial infection and more that 80% of its cases are due to urinary catheters. In this study, bacteria causing urinary infection in spinal cord injured and hospitalized patients have been investigated. Material & Methods. In this descriptive analytic study which was performed from 1384 to 1385, patients were divided in to groups A and B. Group A consisted of 145 spinal cord injured patients who were unable to void bladder naturally and had presented to Al-Zahra hospital, Isfahan due to symptoms of urinary infection. There were 150 hospitalized men with urinary catheter in group B without fever or urinary symptoms at the time of hospitalization that developed symptoms of urinary infection after 48 hours of admission. After completing questionnaire, urine samples were obtained from each person according to bladder voiding method and quickly sent for analysis plus culture. Patients who had taken antibiotics within the preceding 2 weeks were omitted from study. For evaluation of pyuria in diagnosis of urinary infection, patients were divided into 2 groups, one with urinary symptoms and negative urine cultures and the other with urinary symptoms but with positive urine cultures. Statistical analysis was performed using SPSS (version13) software. P<0.05 was considered significant and meaningful difference. Results. The age range of patients under study in group A was 34-54 and in group B was 40-58. There were 120 culture positive cases in group A. According to results obtained from culture of urine samples in spinal cord injured patients, the organisms isolated were E. Coli 64 cases (43.8%), Klebsiella 24 cases(16.4%), Enterococci 11 cases(7.5%), Pseudomonas aeroginosa 10 cases(6.8%), Staphylococcus aureus 5 cases(3.4%), Serratia 3 cases(2.1%), Staphylococcus epidermidis 2 cases (1.4%) and proteus 1 case (0.7%). Most of positive urine cultures were detected in patients who used indwelling catheters. There was a meaningful relation between pyuria and urinary infection (P<0.05). Results of urine cultures from hospitalized patients were as follows: E.coli 85 cases(56.7%), Klebsiella 24 cases(16%), Enterococci 15 cases(10%), Pseudomonas aeroginosa 12 cases(8%), Coagulase negative staphylococci 5 cases (3.3%) and 9 cases (6%) of Staphylococcus aureus, Serratia and Proteus. Discussion. According to the results of this study, the most common organisms causing urinary infection were similar in the two groups and included Escherichia coli, %), Klebsiella, Enterococcus and Pseudomonas in decreasing order of frequency. This similarity could lead us to similar approached to the two groups. One the other hand, colonization of nosocomial organisms in spinal cord injured patients, probably occurs because of repeated hospitalization and catheterization at hospital.

Extravagant use of vancomycin as first line treatment of infections caused by this organism, has led to production of vancomycin resistant staphylococci and enterococci, as an important health problem. The goal of this study was determining sensitivity of S.aureus isolated from clinical specimens outside hospital using E-Test in order to find suitable primary therapeutic method and to reduce vancomycin use.This cross-sectional study was performed in 2006 among 60 samples of community- acquired S.aureus Minimal Inhibitory Concentration (MIC) for various antibiotics against organisms was determined by E-test method. Qualitative control was performed by staphylococcus ATCC29213 and statistical analysis was done by SPSS ver 13 and WHONET- 5 softwares.Overall, 60 patients (including 10 women and 50 men) were included in the study. The specimen studied were 47% from blood, 30% from skin ulcer, 11.7% from evacuated abscess and 8.3% from synovial fluid. Sensitivity percentage of organisms based on break point used in CLSI M7A6 (Clinical & Laboratory Standard Institute) for various antibiotics was 88.6% for Co-Amoxiclav, 81.8% for Amikacin, 79.3% for Gentamicin, 82.1% for Cephalothin, 75% for Ciprofloxacin, 75% for Clindamycin, 76.7% for Oxacillin, 90.5% for Rifampin and 77.8% for Vancomycin. Highest resistance was noted against Oxacillin (p<0.01), Clinidomycin (p<0.01) and aminoglycosides (p<0.05) and definite resistance against Vancomycin was present in only one sample.Staphylococcus aureus is among the most prevalent agents of hospital infection which shows increasing resistance and still has acceptable sensitivity to Cephalothin, Oxacillin and other first- line treatment drugs in community-acquired infections and empirical use of Vancomycin is not necessary in these patients.